Hospital Information Systems
Forecast 2011: Our Experts Cast Their Eyes Toward the Future of Healthcare IT
As we prepare to enter the second decade of the 21st century, industry insiders weigh in on the year ahead in healthcare technology!
ACOs, EHR implementation and integration, social media, ICD-10, the cloud, digital image management and meaningful use are just some of the hot-button topics our panel members address as they consider the next 12 months in healthcare IT.
Editor's note: Because we received so many responses, the forecasts will be split into two parts and concluded next month
Payment bundling and ACOs require new IT strategies
By Ravi Sharma, president and CEO, 4medica
While the bundling of Medicare payments is several years away, United Healthcare and some regional insurers are starting to experiment with the concept. Moreover, accountable care organizations (ACOs) can start participating in a Medicare shared-savings program in 2012. ACOs, which will be responsible for the cost and quality of care, will expand from payment bundling for an episode of care to taking responsibility for the health of an entire population.
Of course, an ACO must be able to coordinate care seamlessly across all care settings. To do that, it must be clinically integrated. This will be easier for healthcare organizations that employ most of their physicians. But at the majority of hospitals, the medical staffs include both employed and private-practice physicians, so hospitals will have to find a way to integrate clinically with those that are not part of their enterprises.
The clinical integration piece depends partly on the intelligent deployment of the best-available information technology. To accept a bundled payment for a procedure and a period of post-acute care, for example, a hospital must collaborate closely with physicians, nursing homes, rehab facilities and home health agencies. Physicians must be able to exchange information online with the hospital and other providers about lab results, medications, allergies and patient health status.
In the best of all possible worlds, the combination of EHRs and HIEs would supply the basis for the exchange of this information. But the fact is that the widespread adoption of these tools is still some years away, while ACOs are right around the corner.
What is needed right now is an easy-to-deploy method of combining patient data across care settings. While there are several different ways to integrate and exchange clinical information, integrated health record (IHR) applications are gaining popularity thanks to their simple, software-as-a-service (SaaS) platform that sits on top of existing technology. Such a system can be used to seamlessly order tests from any lab, receive results, prescribe electronically, view hospital reports and exchange information among providers. Because it can be quickly deployed to practices of all sizes and types — whether or not they have EHRs — the IHR provides an ideal, low-cost vehicle for hospitals to expand clinical integration, prepare for payment bundling and become ACOs.
The year of the community
By Lee Shapiro, president, Allscripts Healthcare Solutions
If 2010 was the year of the electronic health record — a time of adjusting strategies to fit federal incentives for EHR adoption — then 2011 will be the year of the community. As hospitals and physicians move from considering an EHR to actually implementing one, they'll confront the problem of connecting their system to the community of providers around them, most of whom will use someone else's system.
In a true healthcare community, information flows securely but freely between providers, enabling them to work as a team, regardless of their setting. Hospitals and physicians are working to build this community by adopting EHRs and leveraging connectivity to build accountable care organizations (ACOs) that reward quality, outcomes and high-value care.
This trend will accelerate in 2011 as hospitals continue to purchase physician practices. Already the owners of 55 percent of American physician practices, in 2011 hospitals will cement their position as the biggest drivers of change in the environment.
But their vision of integrated healthcare communities will fail if information is bottled up in a closed EHR that cannot connect with third-party systems.
It's easy to see why health systems want an integrated EHR. Most hospital IT departments manage hundreds of interfaces with enormous complexity. Unfortunately, in 2011 more hospitals will confront the cost of integrating using a closed EHR system — ripping out and replacing tens of millions of dollars of third-party applications, a gross waste of scarce healthcare resources.
Thankfully, there is an alternative. A truly open EHR system not only is more affordable and quicker to adopt than a closed EHR, but it spares hospitals and physicians the expense of a rip-and-replace strategy.
In 2011, the choice will become clear. Closed EHR systems make the problems of American healthcare worse. Open systems initiate the future of connected communities, leading to better, more cost-effective patient care for everyone.
Year of the underdog: Cloud-based EHRs
By John Haughton, M.D., chief medical information officer, Covisint
As the new year dawns, physicians face a daunting list of resolutions: meaningful-use deadlines, e-prescribing incentives and penalties, accountable care organizations (ACOs), medical homes and quality initiatives. While predicting increased electronic health-record (EHR) adoption to address these mandates doesn't demand a crystal ball, unknowns still persist.
Physicians are still deliberating how to minimize potential negative impacts of traditional EHR deployment, including:
1. Productivity and revenue losses during and after installation;
2. Office disruption from lack of interoperability with existing practice-management systems and limited data exchange; and
3. Negative long-term impact due to inadequate functionality and future costly upgrades and maintenance.
In response, providers will seek alternatives to traditional, pre-packaged EHRs that roll out with a "big bang" and equally big disruptions. There will be growing interest in modular EHRs that allow physicians to choose which applications they want and when they want them. Using this incremental approach, physicians can avoid practice-wide disruptions by leveraging existing technology investments, selecting "best-of-breed" modules that meet their specific needs and opening a low-cost migration route for satisfying meaningful-use requirements and other incentive programs.
Additionally, physicians will become more acquainted with the newest kid on the block: the cloud-based EHR. Cloud-based, modular EHRs provide the advanced connectivity required to pull data from many disparate sources into a secure, single view of patient information while maintaining the autonomy of each practice's data. Physician practices and hospitals will seek out cloud-based options with a proven track record for security that also enable deep productivity gains: users only need to log in once to access multiple applications and patient views, tapping into both internal and external data sources and systems.
Although still the underdog in healthcare, cloud computing has gained widespread adoption in many industries, and for good reason. With low upfront costs, budget-friendly monthly fees, auditable security, easy-to-use interfaces and the ultimate in accessibility via Internet-enabled devices, the cloud-based EHR isn't the future. It's now.
Automation will be a critical element to enable tactical and strategic initiatives
By Sara McNeil, president, Boston Software Systems
Cost control and revenue cycle management. CPOE (computerized physician order entry). ICD-10 compliance. EMR integration. Meaningful-use standards. RAC audits. More than ever, healthcare organizations are under pressure to implement specific business and clinical initiatives. The carrot the government is dangling in front of hospitals to meet these specific requirements has become a priority for all hospital executives. Critical to these strategic initiatives is to automate the manual tasks and workflows involved and keep major strategies on target.
At a recent conference, I heard one CIO make an interesting statement as he described his hospital's journey toward CPOE. He remarked that the transition team was surprised by how many different ways staff accomplished the same task. They found that each staff group had a slightly different process for completing and submitting reports. The move to CPOE meant finding a common workflow for everyone to use.
This shines a light on how much disparity exists in other areas of the hospital. Different registration personnel, for instance, may regularly ignore particular questions, or each completes the forms in a slightly different way. Just as CPOE can standardize the way clinical personnel handle workflow, automation can help staff throughout the hospital standardize a process.
While most automation tools can help with manual data entry, sophisticated automation technology does that and much more. Hospitals can use automation to manage how the staff interacts with a registration screen, notify stakeholders of critical activities and fill in the gaps between systems and applications that might slow down the revenue cycle.
Automation offers significant advantages to hospital staff, providers and, ultimately, to patients. Hospitals can see greater efficiency throughout the organization to address not only technological and tactical needs, but also strategic business requirements.
Cloudy days ahead: A sunny forecast for digital imaging management
By Mike Wall, CEO, DICOM Grid
As we enter the second decade of the 21st century, we take for granted our ability to tweet, text, share photos, e-mail, blog, post and download. We become annoyed if we experience even a brief delay. It's ironic that we have set the bar so high for non-urgent communications, but we haven't demanded the same degree of convenience and speed to access, annotate and share the medical imaging studies that play such a vital role in diagnosing and treating diseases and medical conditions.
Currently, most imaging data is stored in proprietary data silos, which at best can be accessed by physicians at the facility where the imaging occurred. However, referring physicians or specialists at different organizations are usually out of luck.
This inability to easily search, share and view images and associated data can delay life-saving treatment. Even in less serious situations, patients may be subjected to costly duplicate tests that may be uncomfortable or embarrassing and expose them to radiation.
Fortunately, 2011 will mark the start of a new era in medical image management by leveraging the availability of secure, cloud-based technology that's as easy to use as iTunes, Google or Facebook. Regardless of where and when procedures are performed, the HIPAA-compliant imaging technology will provide instant anywhere/anytime access to all of a patient's pertinent imaging activity on any device equipped with an Internet browser. Physicians will also be able to take advantage of real-time clinical collaboration across all care settings.
This will replace today's antiquated, highly inefficient methods of data access and transport. No longer will imaging studies need to be downloaded onto frequently unreadable CDs that must be hand-delivered by patients or snail-mailed to referring and consulting physicians.
Hospitals and imaging centers will facilitate the transition to seamless image searching, sharing and browsing as well as collaboration within and across organizations as a strategy to retain and increase their physician referral base. They also recognize that in addition to fostering physician loyalty, this technology can provide cost-effective business continuity; disaster recovery; elimination of expensive offsite storage; and compliance with federal and state privacy, data security and retention requirements.
Technology transformation to sweep emergency departments
By Shane Hade, CEO, EDIMS
It is widely perceived that people with non-urgent needs and the uninsured are crowding the nation's emergency departments (ED), helping drive health costs sky high. However, the Centers for Disease Control and Prevention shattered these perceptions after it released a report last May that found the percentage of non-urgent patients had declined from 12 percent in 2006 to 7.9 percent in 2007. Furthermore, the CDC found that seniors and those on Medicaid were most likely to access ED services.
The findings have serious implications for EDs. Observers expect the 32 million uninsured Americans who will be extended insurance to schedule primary-care visits rather than delay or forgo care that could land them in the ED. The argument is logical except that many patients presenting at the ED have insurance and urgent problems. Health reform — plus the first wave of 78 million baby boomers turning 65 this year — will increase, not decrease, the burden on EDs.
Before the meaningful-use final rule made EDs eligible for incentives, hospitals were concentrating on automating the inpatient environment. Now, they will expand their focus to automating and integrating the ED with the inpatient side, giving them the global data they need to address one of the highest medical cost areas.
Additionally, hospitals will make process improvements, such as building "fast-track" areas to address patients with non-urgent problems and adding observation areas to determine whether people really need emergency care. EMRs will be the linchpin that makes these different areas of the hospital work together.
Look to ACOs for value-based delivery
By Kerry Winkle, chief marketing officer, Eldorado, an MphasiS Company
While Medicare is leading the way to reform healthcare delivery with accountable care organizations (ACOs), many payers and providers see ACOs as a way to generate more targeted revenue and improve the quality of healthcare.
Hospital system-sponsored ACOs will require hospitals to become payers overnight. Health plan-sponsored ACOs may benefit from integrated claims and care management systems that will give them a leg up on identifying at-risk populations and opportunities for cost savings.
ACOs represent a distinct opportunity to improve on the payer-controlled case management of the 1980s. Comprehensive patient care management under ACOs will be directed by the primary care provider, who will be accountable for and incentivized to improve outcomes through preventive initiatives and promote wellness, disease management and proactive population management based on predictive modeling analytics.
Single- and multi-payer pilots will require an unprecedented level of interoperability and rely on technologies such as SOA/Web services in order to achieve the desired level of highly coordinated quality care and benefit from cost savings. Beyond EHRs, ACOs must be able to connect and correlate membership demographics, analytic tools, medical and pharmacy claims, lab data and more. And on a broader scale, they must also be able to integrate with health information exchanges (HIEs) on local, regional and (later) national levels.
Empowering the small practice with EHRs
By Tom Giannulli, M.D., chief medical information officer, Epocrates
There has been much discussion about electronic health record (EHR) adoption. However, many EHR systems are designed for hospitals and large institutions, and they are often prohibitively complex and costly for smaller practices.
In 2011, I know firsthand that there will be more EHR solutions designed specifically for smaller group practices. This will allow physicians to adopt the technology without turning into IT administrators. SaaS-based EHRs will become more common as a way to offer a cost-effective and secure solution for implementation. This eliminates the hurdles of the time and cost commitment of a full-scale, server-based EHR. SaaS EHR solutions allow physicians to have uninterrupted access to patient data via the Web. EHRs need to be designed to maximize today's technology and be customizable for different practices. Specific needs that will be addressed for office-based physicians will include mobility and intuitive interfaces.
I believe that between the HITECH Act incentives and the availability of more physician-centric solutions, 2011 will be the year of widespread EHR adoption.
A more meaningful meaningful use
By Brandon Savage, M.D., chief medical officer, GE Healthcare IT
Striving to improve the quality of the U.S. healthcare system, the government will invest about $30 billion in healthcare IT over the next decade, including financial incentives for healthcare providers who adopt electronic health records and demonstrate meaningful use. The bar set for meeting the first stage of meaningful use, which starts in 2011, ensures an effective start for the program, with expectations to increase rigor every two years. This will enable a shift from a structured data capture and exchange focus to one that addresses improved healthcare outcomes and advanced care processes.
In the next year, healthcare leaders will begin to look beyond just meeting the initial requirements and drive toward making meaningful use meaningful for their organizations. An increasing number of CIOs will realize that they need to generate long-term value from meeting initial and subsequent meaningful-use measures and prepare for the future. They'll participate in emerging models, such as value-based payment, patient-centered medical homes and accountable care organizations.
There has also been a growing and appropriate systemic shift toward patient financial accountability as well as provider/patient engagement. Providers know patients, in turn, will demand more transparency and choice as they bear a higher proportion of healthcare costs and have access to more information on their care. Meanwhile, government and private payer value-based payment standards are forcing more financial and quality benchmarking, and although some CIOs will undoubtedly remain focused on meeting just the initial bare minimum, this groundswell will force an unmistakable tipping point. Meaningful meaningful use will pull away from ordinary meaningful use and benefit the smart healthcare systems employing it. These are the organizations that will drive better optimization of cost, quality and access and leverage the ARRA reimbursement's once-in-a-lifetime opportunity for many lifetimes to come.
EHRs: Finding new approaches to integration
By Alan Portela, president, CliniComp
With the passage of the HITECH Act and rules regarding meaningful use, the federal government has taken a leading role in creating urgency in the adoption of electronic health records (EHRs).
During the past decade, healthcare organizations have invested billions of dollars in failed attempts to adopt comprehensive EHRs (less than 10 percent adoption). Today's biggest challenge is the lack of automation in inpatient, mission-critical clinical areas (such as EDs, ICUs, ORs), as well as the integration of systems to address key strategic initiatives (i.e., medication error reduction that requires CPOE, eMAR, bar coding, pharmacy, dispensing).
The need to reach 100 percent adoption during the next five years is prompting healthcare organizations to seek a new approach optimizing the existing infrastructure and the automation of functional care-setting suites (FCSS) covering existing operational and clinical gaps, rather than replacing the entire infrastructure with a solution from one vendor the way it was done over the past decade.
The recommended approach is "best of suite," covering functional care-setting suites and combining fully integrated "best-of-breed" applications, meeting the needs of caregivers while improving clinical workflow and matching the organization's strategic initiatives. We should start with meaningful-use compliance as the top strategic initiative, which requires two key components: meaningful data (mission-critical areas) and meaningful use (clinician adoption).
The need for developing a transitional strategy without disrupting the current workflow is crucial to EHR modernization. Systems must be able to support open standards as well as effectively communicate information without requiring extensive tailoring of the core infrastructure.
The challenge for large healthcare institutions while upgrading their clinical applications is the scale of migration and integration with existing infrastructure while meeting operational and clinical needs.